Institute of MarketingCommunications India

REGISTRATION FORM

Programme:
Mode:
Please Note:
1. Please complete all the information accurately. Incomplete or false information may make
your candidature null and void.
2. The decision of the Institute will be final and binding on the applicants in all the matters
relating to registration. If the institute rejects any application, full refund will be made.
3. For details for the programme, please visit www.imciindia.org.
4. You are required to enclose soft (scanned) copies of all relevant testimonials along with the
registration form.

The completed registration form should be emailed and addressed to the Director, Institute of
MarketingCommunications India (IMCI),SatsangViharMarg, A-14/B, A Block, Qutab Institutional
Area, Near Old JNU Campus New Delhi-110067,India to email ID info@imciindia.org.
Phone: +91 9650304949, 01145053984

Application Details
Amount Rs.:
Demand Draft/CHQ No.:
Affix a recent
Dated: coloured passport
Bank: size photograph
PayU/NEFT Reference no:

Registration Number

*Crossed DD or Cheque should be in favour of “Institute of MarketingCommunications India”

payable at New Delhi. Please write your name and address at the back of DD/Cheque. Applicable
examination fee can be paid later as per the Institute’s examination notification.

PERSONALINFORMATION

1. Full Name:
2. Address of correspondence (in capital letters)
Postal code/Zip code
3. Mobile no.:
4. Date of Birth:
5. Gender:
6. Mother’s Name:
7. Father’s Name:
8. Email Id:
9. Phone no with STD code.:
10. Nationality:
11. Category:
(SC: Scheduled Caste; ST: Scheduled Tribe; PH: Physically Handicapped; EWS: Economically
Weaker Sections; Ex-servicemen; Attached copy of the certificate as applicable for 10% fee
Concession)

WORKEXPERIENCE

12. Work Experience (If any)

i. Total work experience: Year Months
ii. List all your work

From To Total Name the Designation Brief job profile

completed organization
months

ACADEMIC QUALIFICATIONS

13. Pre-Bachelor’s Degree Examination(s):

Std. School/ Board/ Year % Marks Class/
Institute University completed Obtained Division
10th
High School
12th
Intermediat
e

14. Bachelor’s Degree Examination(s):

Degree Obtained Subject/Specialization

College/Institute University

Year Marks considered for award of Class/Division in Bachelor’s

From To
CGPA/ % of Marks obtained/ Grade
(DD/MM/YYYY) (DD/MM/YYYY)
15. Post-Graduation Degree/Diploma (if any):
Degree Obtained Subject/Specialization

College/Institute University

Year Subject % of Marks obtained

From To
(DD/MM/YYYY) (DD/MM/YYYY)

16. Professional qualification (if any):

Degree Obtained Subject/Specialization

College/Institute University

Year Subject % of Marks obtained

From To
(DD/MM/YYYY) (DD/MM/YYYY)

DECLARATION

I have carefully filled up all the information and agree to abide by the decision of the Institute of
MarketingCommunications India, New Delhi authorities regarding my registration. I certify that the
particulars given by me in the form are true to the best of my knowledge and belief.

Date
Place Signed by (write your full name here)